Malignant pleural mesothelioma (MPM) is an aggressive disease with poor prognosis and the current treatment for early-stage MPM is based on a multimodality therapy regimen involving platinum-based chemotherapy preceding or following surgery. To enhance the cytoreductive role of surgery, some peri- or intra-operative intracavitary treatments have been developed, such as hyperthermic chemotherapy, but long-term results are weak. The aim of this study was to report the post-operative results and mid-term outcomes of our multimodal intention-to-treat pathway, including induction chemotherapy, followed by surgery and Hyperthermic Intraoperative THOracic Chemotherapy (HITHOC) in the treatment of early-stage epithelioid MPM. Since 2017, stage I or II epithelioid MPM patients have been inserted in a surgery-based multimodal approach comprising platinum-based induction chemotherapy, followed by pleurectomy and decortication (P/D) and HITHOC with cisplatin. The Kaplan–Meier method was used to estimate overall survival (OS), disease-free survival (DFS) and progression-free survival (PFS). During the study period, n = 65 patients affected by MPM were evaluated by our institutional Multidisciplinary Tumour Board; n = 12 patients with stage I-II who had no progression after induction chemotherapy underwent P/D and HITHOC. Post-operative mortality was 0, and complications developed in n = 7 (58.3%) patients. The median estimated OS was 31 months with a 1-year and 3-year OS of 100% and 55%, respectively. The median PFS was 26 months with 92% of a 1-year PFS, whereas DFS was 19 months with a 1-year DFS rate of 83%. The multimodal treatment of early-stage epithelioid MPM, including induction chemotherapy followed by P/D and HITHOC, was well tolerated and feasible with promising mid-term oncological results.

Background/Objectives: Sleeve and wedge bronchial resections without removal of lung tissue may represent a surgical option in selected cases of low-grade neoplasms. This study is a retrospective analysis of the surgical technique and the short- and long- term results of bronchial sleeve resections performed in the Department of Thoracic Surgery of Careggi Hospital in Florence, Italy, and in the Department of Thoracic Surgery of Marie Lannelongue Hospital in Plessis Robinson, France. Methods: Between January 2017 and October 2024, 25 patients with low-grade tumors underwent bronchial sleeve resection with total lung-sparing. We collected the preoperative data, surgical techniques, postoperative results and long-term oncologic outcomes. Results: We performed 25 bronchial sleeves which resulted in 20 typical carcinoids (TC), 3 atypical carcinoids (AT) and 2 mucoepidermoid carcinomas. Three patients had R1 resection, and one of them also had N1 disease; a multidisciplinary team opted for a “watch and wait” policy without adjuvant therapies. No local recurrences occurred, although three distant recurrences were observed. The five-year overall survival (OR) rate was 100%; the five-year disease-free survival (DFS) rate was 80%. Conclusions: Bronchoplastic procedures without lung parenchyma resection are an appropriate and feasible technique for selected cases of low-grade endobronchial neoplasms.